INCIDENCE, SEVERITY AND TIME COURSE OF PRESSURE INJURIES IN PEOPLE WITH SPINAL CORD INJURIES IN BANGLADESH

P. D. Costa¹, L.A. Harvey², M.S. Hossain¹, S. Islam¹, A. Rahman¹, J.V. Glinsky², H. Liu³, S. Jan³, I.D. Cameron², R.D. Herbert⁴

¹Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh, ²The University of Sydney, Sydney, Australia, ³George Institute for Global Health, Sydney, Australia, ⁴Neuroscience Research Australia (NeuRA), Sydney, Australia

Background: Pressure injuries are a serious complication of spinal cord injury (SCI), especially in low-and middle-income countries (LMICs). They cause functional limitations, affect quality of life, and are a major cause of death. Despite the problems pressure injuries pose for people with SCI in LMICs, there are few accurate data from these countries about the incidence or severity of pressure injuries.

Purpose: The aim of this study was to determine the incidence, severity, and time course of pressure injuries over the first two years following discharge from hospital in people with SCI in Bangladesh.

Methods: This study was a longitudinal cohort study embedded in a randomised clinical trial (namely CIVIC Trial). Participants were 186 of 204 people in the intervention arm of the clinical trial. They were contacted by telephone every two weeks over the first year and every month over the second year following discharge. On average, participants were contacted by telephone 39 times over the two years following discharge. At each point of contact, they were asked if they had a pressure injury and if so, the severity of pressure injuries were determined using the Pressure Ulcer Scale for Healing (PUSH). In addition, four to six in-person assessments were conducted over the two years. The incidence rate of first pressure injuries was determined by dividing the number of first pressure injuries by the total person time at risk (i.e., total time observed prior to first pressure injuries). To quantify the severity of participants’ pressure injuries, the median peak and mean PUSH scores of all pressure injuries were determined. Survival analyses were conducted to determine the time course of development of pressure injuries and recovery from pressure injuries. Lasso regression was used to construct multivariable prediction models.

Results: Seventy-seven participants (41%; 95% CI 34% to 49%) developed at least one pressure injury in the first two years after discharge. The incidence rate was 0.27 per person-year (95% CI 0.22 to 0.34). Twenty-one participants (11%) developed a pressure injury within 3 months of discharge. Most pressure injuries were on the sacrum (23%) and took a median (IQR) of 40 (29 to 57) days to heal. The median (IQR) peak PUSH score was 11.0/17 (8.0 to 13.5) and mean PUSH score was 7.7 (6.4 to 10) respectively. Twelve participants died. The multivariate prediction models were not very predictive (maximum c-statistic 0.75).

Conclusions: Pressure injuries impose a large health burden on people with SCI in Bangladesh. However, they are difficult to predict. Further studies are needed to identify those at most risk and to find effective solutions for the treatment and prevention of pressure injuries appropriate for Bangladesh and other LMICs.

Implications: This study highlights the problems pressure injuries pose to people with SCI in Bangladesh and other LMICs. The study findings will help draw the problems to the attention of the public, policy makers and academics. These data could be used to assess change over time. In addition, the results of the study will serve as baseline data upon which to determine the effectiveness of future interventions.

Funding acknowledgements: The CIVIC trial was funded by the National Health and Medical Research Council of Australia.

Keywords:
Pressure injury
Spinal cord injury
Community Based Rehabilitation

Topics:
Neurology: spinal cord injury
Community based rehabilitation
Disability & rehabilitation

Did this work require ethics approval? Yes

Institution: Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh

Committee: Centre for the Rehabilitation of the Paralysed Ethics Committee (CRPEC), Bangladesh

Ethics number: CRP-R&E-0401-126